Citation Nr: 9830289
Decision Date: 10/09/98 Archive Date: 10/21/98
DOCKET NO. 97-10 121A ) DATE
)
)
On appeal from the
Department of Veterans Affairs Regional Office in Buffalo,
New York
THE ISSUE
Entitlement to service connection for allergic rhino-
conjunctivitis.
WITNESS AT HEARING ON APPEAL
Appellant
ATTORNEY FOR THE BOARD
D. A. Saadat, Associate Counsel
INTRODUCTION
The veteran had active military service from August 1981 to
February 1995.
The issue on appeal arises from a January 1996 rating action,
in which the aforementioned regional office (RO), in
pertinent part, denied service connection for allergic rhino-
conjunctivitis. The veteran filed a notice of disagreement
in January 1997 and a statement of the case was issued in
February 1997. In April 1997, the veteran filed a written
statement which was accepted by the RO as a substantive
appeal. By a June 1997 rating action, the RO continued to
deny service connection for allergic rhino-conjunctivitis.
The veteran testified before a local hearing officer in June
1997. By a February 1998 rating action, the RO continued to
deny service connection for allergic rhino-conjunctivitis. A
supplemental statement of the case was issued later that
month.
CONTENTIONS OF APPELLANT ON APPEAL
The veteran essentially contends that she is entitled to
service connection for allergic rhino-conjunctivitis.
DECISION OF THE BOARD
The Board of Veterans' Appeals (Board), in accordance with
the provisions of 38 U.S.C.A. § 7104 (West 1991 & Supp.
1997), has reviewed and considered all of the evidence and
material of record in the veteran's claims file. Based on
its review of the relevant evidence in this matter, and for
the following reasons and bases, it is the decision of the
Board that the preponderance of the evidence is against the
claim concerning service connection for allergic rhino-
conjunctivitis.
FINDING OF FACT
The veteran’s allergic rhino-conjunctivitis is an acute and
transitory disorder, resolving without residuals in the
absence of the offending allergen.
CONCLUSION OF LAW
The veteran does not have chronic allergic rhino-
conjunctivitis which was incurred in or aggravated by
service. 38 U.S.C.A. §§ 1110, 1131 (West 1991 & Supp. 1998);
38 C.F.R. § 3.380 (1998).
REASONS AND BASES FOR FINDING AND CONCLUSION
I. Factual Background
Service medical records reflect that the veteran was examined
for purposes of appointment/commission in October 1980.
Prior to the examination, the veteran denied any history of
eye trouble, nose or throat trouble, chronic or frequent
colds or hay fever. It was noted, however, that the veteran
had allergic reactions to certain medications. Upon
examination, the veteran's nose, sinuses, mouth, throat and
eyes were found to be normal.
In February 1982, while the veteran was at Fort Knox, she
complained of having a cold for the prior eight hours. Upon
examination, the veteran's tympanic membrane was intact and
her chest was clear to auscultation and percussion. Her neck
was supple and the throat had no exudate, though some edema
was noted. The abdomen was non-tender. The impression was
that the veteran had an upper respiratory infection. In
March 1982, the veteran complained of a sore throat,
hoarseness and difficulty swallowing. She denied sinus
congestion but did have rhinitis. The veteran also
complained of ear congestion and a feeling of fullness on
swallowing. An examination revealed that the veteran's
throat and tonsils were slightly swollen and reddened. Post-
nasal drip was seen. There was no exudate and the veteran's
lungs were clear. The veteran's left tympanic membrane was
clear with good light reflex and movement. The right
tympanic membrane had good reflex and movement, though a few
air bubbles were seen. The veteran was assessed as having
probable sinus congestion with sore throat.
In August 1983, the veteran complained of chills and malaise
for the prior five hours. It was noted during the
examination that the veteran had slightly inflamed mucosa
with clear discharge. The veteran's pupils were equal, round
and reactive to light and accommodation. Her tympanic
membranes were normal with few serous bubbles seen
bilaterally. The throat was unremarkable. The veteran was
diagnosed/assessed as having viral upper respiratory
infection.
In December 1983, the veteran complained of headache, sore
throat, chills and intermittent sinus congestion. There was
green to yellow sputum, but mostly a dry cough. The veteran
reported that two of her brothers had strep. She also
complained of some nausea. Upon examination, the veteran's
throat was noted to be infected, though no nodes were found.
The neck was supple and the lungs were clear. The veteran
was assessed as having probable strep.
In September 1984, the veteran was seen in an emergency room
setting, complaining of sore throat and malaise. An
examination revealed that the veteran's extraocular muscles
were intact and her pupils were equal, round and reactive to
light. The tympanic membranes were clear. The throat was
erythematous, though there were no exudates. The neck was
supple and the lungs were clear. The veteran was assessed as
having an upper respiratory infection.
In November 1985, while the veteran was serving in Yuma,
Arizona, she complained of congestion, body aches, chills and
pain in her right ear. She had a cough productive of sputum
and night sweats. The veteran's tympanic membranes were
clear, though the right tympanic membrane was retracted. The
nose had increased interior turbinates. There was post nasal
drip also noted. The lungs were essentially clear
throughout. The veteran was assessed as having a viral upper
respiratory infection. The veteran continued to seek
treatment for this condition subsequently in November 1985.
In June 1986, the veteran underwent a periodic examination.
No abnormalities were noted regarding the veteran's nose,
sinuses, mouth and throat, ears or eyes.
In August 1986, the veteran complained of bilateral ear ache,
sinus congestion, pharyngitis and productive coughing for the
prior five days, without resolving on its own. An
examination revealed that the conjunctiva were clear. The
right tympanic membrane revealed erythema with decreased
motility, while the left tympanic membrane was erythematous
with normal motility. The pharynx was clear and sinuses had
no tenderness. The neck was supple without adenopathy. The
lungs were clear to auscultation and examination of the
abdomen was benign. The veteran was diagnosed as having
right otitis media.
In April 1988, the veteran was seen at the Walter Reed Army
Medical Center and complained of muscle aches, sore throat,
stuffy nose and a full feeling in her ears. The veteran
reported contact with a relative who had been diagnosed as
having strep throat. An examination revealed an erythematous
oropharynx with no neck nodes. The tympanic membranes were
normal, but boggy nasal turbinates were found. The veteran
was assessed as having viral upper respiratory infection.
In June 1990, the veteran presented with a sore throat and
nasal congestion for the prior three to four days. The
veteran took medication without relief. She denied
rhinorrhea, fever, myalgia, cough or headache. The veteran
denied any complaints secondary to nasal congestion and also
denied any history of allergy. She did note that her ears
were “plugged up.” Later in the this report, the veteran
was noted to have indicated that she had mild allergy
symptoms in the prior year, including sneezing. An
examination revealed that the veteran's pupils were equal,
round and reactive to light and accommodation, and
extraocular muscles were intact. The veteran's throat and
tympanic membranes were clear. Sinuses were without
tenderness bilaterally. There were no neck nodes and the
lungs were clear to auscultation and percussion. The veteran
was assessed as having allergic rhinitis.
The veteran was referred for a consultation in
allergy/immunology, where she reported “June” symptoms for
two years in a row, both ocular and nasal. It was worse
outside an air conditioned environment and when outdoors. An
examination revealed epiphora and pale, boggy nasal mucosa.
The veteran was assessed as having allergic rhino-
conjunctivitis, probably grass pollen, related to increased
outdoor exposure.
In March 1991, the veteran complained of nausea, myalgia,
increased chills and increased malaise. There was no
vomiting or diarrhea. Upon examination, there was no mastoid
tenderness. The veteran's neck was supple and there were no
nodes. The lungs were clear. The abdomen was soft and
nontender and the veteran's skin was warm and dry. The
veteran was assessed as having gastritis/viral syndrome.
In April 1993, while at the 121st Evacuation Hospital in
Seoul, South Korea, the veteran presented with cold symptoms,
including a nonproductive cough. There was clear to yellow
nasal discharge and sinus congestion and tenderness. There
was no sinus tenderness and the veteran's tympanic membranes
were clear, bilaterally. The pharynx had minimal erythema.
The veteran was assessed as having sinus congestion.
In November 1994, the veteran was examined for separation
purposes at Walter Reed. Prior to the examination, the
veteran denied any history of eye trouble or hay fever. She
reported having two to three colds every winter and having
had allergic rhino-conjunctivitis in June 1990. Upon
examination, no abnormalities were noted regarding the
veteran's nose, sinuses, mouth, throat, ears or eyes.
In February 1995, the veteran filed a claim concerning, in
part, allergic rhino-conjunctivitis.
The veteran underwent an examination for VA purposes in May
1995. She reported, in pertinent part, that she had been
discharged recently from the service. She had had upper
respiratory infections and was treated for episodes of
bronchitis in 1982, when she was given antibiotics. In 1987,
she again had cough, sinus infection and ear problems while
flying. This cleared up after another course of antibiotics.
In 1988, she had a streptococcus throat proven by culture,
and this was treated with penicillin. While in Washington,
D.C. in 1988, 1989 and 1990, she had a problem with allergic
rhino-conjunctivitis and was treated in an allergy clinic.
This rhino-conjunctivitis was seasonal and usually occurred
in June. At the time of the VA examination, the veteran's
breathing was normal and her ears were no longer a problem.
Following an examination, the veteran was diagnosed as
having, in part, allergic rhino-conjunctivitis, seasonal,
moderate.
By a January 1996 rating action, the RO, in pertinent part,
denied service connection for allergic rhino-conjunctivitis.
In her January 1997 notice of disagreement, the veteran
asserted, in pertinent part, that the medical records
reflected that she had sought medical care for nasal, ear and
sinus congestion on numerous occasions. It was not until she
was assigned to Walter Reed Army Hospital that she was
referred to an allergist who diagnosed her as having allergic
rhino-conjunctivitis. At the time of her VA examination, the
veteran informed the VA examiner that she suffered from
seasonal rhino-conjunctivitis. She did not have “sinus
problems” prior to being assigned to Fort Knox. She now had
sinus problems yearly with ragweed in Western New York. When
she was assigned to Walter Reed Army Medical Center, her
problems started in June with the pollens and grass there.
During a routine medical examination at the Veterans
Administration Medical Center (VAMC) in Buffalo, New York,
the nurse practitioner noticed that the veteran had symptoms
of allergic rhino-conjunctivitis, for which she was
prescribed medication. One week later, the veteran needed
these medications because she was suffering from allergies.
According to the veteran, had she been employed at the time,
she would not have been able to work for four days due to
headache and severe sinus congestion. She did not have the
option of scheduling her examination to verify this problem
when it occurred. Rather, the examination was at the time
chosen by the VA. At the time of her VA examination,
according to the veteran, she did not exhibit symptoms as it
was not during ragweed season or a time of high pollen count.
In March 1997, medical records from Buffalo VAMC were
associated with the claims file. These records reflect
outpatient treatment of the veteran from May 1996 through
September 1996. These records do not reflect any complaints
of or treatment for allergies or rhino-conjunctivitis.
In April 1997, the veteran filed a written statement which
was accepted by the RO as a substantive appeal, in lieu of a
Form 9. The veteran asserted, in pertinent part, that her
medical record reflected numerous incidences in which she
sought medical care for symptoms such as runny nose, head
cold and ear congestion. It was not until she was stationed
at Walter Reed that she had symptoms severe enough to be
referred to an allergist. Prior to entering active duty, she
did not have sinus problems, nor did she suffer from seasonal
allergies. She was stationed at Fort Knox for her first duty
station. Fort Knox, according to the veteran, was an area
where many people suffered from allergies. Examples of when
she sought care for complaints such as sinus congestion were
in February 1982, March 1982, March 1983 and August 1983.
The veteran believed this was her first exposure to allergens
that began the sensitization of her body to such substances.
The veteran further asserted that while stationed in Yuma,
Arizona, she continued to have problems. In November 1985,
her health care records indicated that her right tympanic
membrane was retracted, and she had nasal congestion. These
were signs, according to the veteran, of allergic rhino-
conjunctivitis. In November 1986, the veteran complained of
ear ache and had erythema of the right tympanic membrane with
decreased motility. Upon assignment to Walter Reed, she
began having problems again. The problems increased with
increased exposure to allergens and an allergist diagnosed
her as having allergic rhino-conjunctivitis.
The veteran further stated that upon her return to the
Buffalo area, she again started to have seasonal problems
with allergies. She was out of town on vacation in August
1995, the allergy season in Buffalo, but in August 1996, it
was noted by a VA health care provider that the veteran had
signs and symptoms of allergic rhino-conjunctivitis. She was
prescribed medication.
The veteran reasserted that the RO ignored the seasonal
nature of allergic rhino-conjunctivitis when it denied her
claim based on an examination conducted when she was not
suffering from the problem. The veteran asserted that her
allergic rhino-conjunctivitis developed with her exposure to
allergens at Fort Knox, Yuma and Washington, D.C., and that
the exposure sensitized her to the ragweed allergens of the
Western New York area. This was a problem that had increased
with severity over the course of time, especially with each
successive exposure to allergens.
By a June 1997 rating action, the RO continued to deny
service connection for allergic rhino-conjunctivitis.
The veteran testified before a local hearing officer in June
1997. She stated that prior to being on active duty, she
never suffered from allergies or hay fever-type symptoms,
while living the great majority of her life in the western
New York area. There was a short period that she lived in
Texas, however. Within the eight months she had been in Fort
Knox, the veteran started getting some symptoms very similar
to allergies. These symptoms included runny nose, nasal
congestion, and watery and itchy eyes. The veteran was
usually seen by either a non-physician health care provider
or a general practitioner who would see that she had symptoms
like ear congestion or “ear bubbles,” which could have been
regarded either as a common cold or as an allergy. The
veteran’s symptoms during these allergic attacks worsened and
once when she was in Yuma, she was barely functional. She
had to take a controlled substance for the headaches she had
from the sinus congestion. The veteran started having more
allergic reactions in Yuma, depending on the growing seasons.
As she was traveling near farms, she would get allergic
reactions like watery eyes and sneezing.
When the veteran moved to Washington, D.C., her severe sinus
congestion and massive headaches made her barely functional.
In June 1990, the veteran went to an emergency room and was
then referred to an allergy specialist, who gave her some
medication. The specialist wanted to have the veteran
tested, but the veteran decided not to be tested due to her
concerns about the Gulf War and her upcoming duties as a
nurse. She thought she would just have to suffer through it
and take care of real patients. The veteran also asserted
that because she was a nurse and had a knowledge base
regarding over-the-counter medications, often she would self-
treat her more minor allergy symptoms. The veteran also
indicated that, after reviewing her record, sometimes
physicians would provide her medications without documenting
her complaints.
The veteran speculated that when she moved to Kentucky, her
body was exposed to an allergen and was sensitized. The
veteran further testified that she had an allergic reaction
while in Washington, D.C. and continued to be allergic after
she moved back to Buffalo. She would experience symptoms in
the spring and in the late summer. These symptoms would last
about six or seven weeks. Currently, the veteran was using
over-the-counter medications to treat her condition, without
seeing a physician. The previous summer, the veteran had
visited the VAMC and was given medication. This was at a
time when apparently only minute amounts of pollen were in
the air. The veteran indicated that she had not undergone
full allergy testing.
In the course of her local hearing, the veteran submitted
several documents in support of her claim, and these
documents were associated with the claims file. These
include three articles from Internet web pages. One article
is entitled “What Are Allergies?” and gives general
information about the symptoms and mechanics of allergic
response. Another article is called “Welcome To The Allergy
Shop!” and contains information on how an allergy develops
and various treatments available. In another article,
entitled “Answers From the Experts,” Eli Meltzer, M.D.,
answers general questions regarding allergies.
Finally, the veteran also submitted the detailed instructions
and indications which accompanied a pocket inhaler product
apparently prescribed by a VA physician.
In October 1997, additional medical records from the Buffalo
VAMC were associated with the claims file. These records
reflect, in pertinent part, that in January 1997, the veteran
was noted to have inactive allergic rhinitis.
In December 1997, medical record from the Women’s Wellness
Center, associated with the VA Western New York Healthcare
System, were associated with the claims file. These records
reflect that in August 1996, the veteran visited the Center
as a new patient with no complaints. It was noted that the
veteran was taking medication for allergies. Following an
examination, the veteran was assessed as having, in pertinent
part, allergic rhinitis/post-nasal drip, and was prescribed
medication for this condition. The veteran was also assessed
as having wheezing.
By a February 1998 rating action, the RO continued to deny
service connection for allergic rhino-conjunctivitis.
II. Analysis
The Board finds that the veteran's claim is well grounded
within the meaning of 38 U.S.C.A. 5107(a). That is, the
veteran is found to have presented a claim which is not
inherently implausible. Furthermore, upon examination of the
record, the Board is satisfied that all relevant facts have
been properly developed in regard to his claim, and no
further assistance to the veteran is required to comply with
the duty to assist, as mandated by 38 U.S.C.A. 5107(a).
Service connection may be granted for disability resulting
from disease or injury incurred in or aggravated by service.
38 U.S.C.A. §§ 1110, 1131 (West 1991).
Federal regulations further provide as follows:
Diseases of allergic etiology, including
bronchial asthma and urticaria, may not
be disposed of routinely for compensation
purposes as constitutional or
developmental abnormalities. Service
connection must be determined on the
evidence as to existence prior to
enlistment and, if so existent, a
comparative study must be made of its
severity at enlistment and subsequently.
Increase in the degree of disability
during service may not be disposed of
routinely as natural progress nor as due
to the inherent nature of the disease.
Seasonal and other acute allergic
manifestations subsiding on the absence
of or removal of the allergen are
generally to be regarded as acute
diseases, healing without residuals. The
determination as to service incurrence or
aggravation must be on the whole
evidentiary showing.
38 C.F.R. § 3.380 (1998).
In this case, the evidence clearly shows that the veteran was
not diagnosed with allergic rhino-conjunctivitis prior to her
entry into service. Indeed, the first diagnosis of this
condition was provided in June 1990. At that time, the
veteran had reported that she had experienced “June”
symptoms for the prior two years. It was noted that the
veteran's allergic rhino-conjunctivitis was related to
increased outdoor exposure and probably caused by exposure to
grass pollen. Following her post-service examination for VA
purposes, the veteran was diagnosed as having the same
condition, which was specifically noted to be seasonal. As
detailed above, regulations provide that a condition of this
nature is to be regarded as acute in nature.
While the veteran has argued that she had suffered from this
condition throughout her period of active duty and following
discharge, the record reveals that the veteran has sought
treatment for cold-like symptoms at various times, often
separated by many months or years. By the veteran's own
admission, she exhibits symptoms of rhino-conjunctivitis
during ragweed season or at times of high pollen count. She
has also noted that her symptoms (or lack there of) while on
active duty often depended on where she was stationed and the
types of pollens and grasses present at these locations.
This evidence suggests the transitory nature of her
condition.
The Board does not find the web page articles submitted by
the veteran persuasive in relation to her claim. While these
articles discuss the symptoms and treatment of allergies in
general terms, they do not provide any specific information
as to any link between this particular veteran’s allergic
rhino-conjunctivitis and her period of active duty.
Thus, as the preponderance of the evidence supports the
finding that the veteran's allergic rhino-conjunctivitis is
an acute disease which heals without residuals with the
removal of the allergen, service connection for allergic
rhino-conjunctivitis is denied.
ORDER
Entitlement to service connection for allergic rhino-
conjunctivitis is denied.
Iris S. Sherman
Member, Board of Veterans' Appeals
NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West
1991 & Supp. 1998), a decision of the Board of Veterans'
Appeals granting less than the complete benefit, or benefits,
sought on appeal is appealable to the United States Court of
Veterans Appeals within 120 days from the date of mailing of
notice of the decision, provided that a Notice of
Disagreement concerning an issue which was before the Board
was filed with the agency of original jurisdiction on or
after November 18, 1988. Veterans' Judicial Review Act,
Pub. L. No. 100-687, § 402, 102 Stat. 4105, 4122 (1988). The
date which appears on the face of this decision constitutes
the date of mailing and the copy of this decision which you
have received is your notice of the action taken on your
appeal by the Board of Veterans' Appeals.
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